Influence of Pullback Pressure Gradient on Residual Angina at One Year

Authors

• Takuya Mizukami
• Kazumasa Ikeda
• Daniel Munhoz
• Koshiro Sakai
• Jeroen Sonck
• Hitoshi Matsuo
• Toshiro Shinke
• Hirohiko Ando
• Brian Ko
• Simone Biscaglia
• Fernando Rivero
• Thomas Engstrøm
• Antonio Maria Leone
• Lokien X van Nunen
• William F Fearon
• Evald Høj Christiansen
• Stephane Fournier
• Liyew Desta
• Andy Yong
• Julien Adjedj
• Javier Escaned
• Masafumi Nakayama
• Ashkan Eftekhari
• Frederik M Zimmermann
• Tatyana Storozhenko
• Frédéric Bouisset
• Domenico Galante
• Bruno R da Costa
• Gianluca Campo
• Colin Berry
• Damien Collison
• Tetsuya Amano
• Divaka Perera
• Allen Jeremias
• Ziad A Ali
• Ethan Korngold
• Eric Wyffels
• Adriaan Wilgenhof
• Nico Pijls
• Bernard De Bruyne
• Nils P Johnson
• Carlos Collet

Language

English

Publication Date

3-1-2026

Journal

Circulation: Cardiovascular Interventions

DOI

10.1161/CIRCINTERVENTIONS.125.015851

PMID

41623057

PMCID

PMC12991326

PubMedCentral® Posted Date

2-2-2026

PubMedCentral® Full Text Version

Post-print

Abstract

Background: The pullback pressure gradient (PPG) is a novel physiological metric that quantifies coronary artery disease patterns as focal or diffuse on a scale from 0 to 1. This study assessed the relationship between PPG and residual angina at 1 year.

Methods: PPG Global is a prospective, investigator-initiated, single-arm, multicenter study that enrolled patients with at least 1 lesion with a fractional flow reserve ≤0.80 intended to be treated with percutaneous coronary intervention. After the PPG calculation, physicians could revise treatment assignment to medical therapy or coronary artery bypass graft surgery instead of percutaneous coronary intervention. Focal and diffuse disease were defined based on the median PPG value of 0.62. Patient-reported outcomes were assessed using the Seattle Angina Questionnaire at baseline and 1-year follow-up.

Results: The study included 947 patients with PPG and the Seattle Angina Questionnaire at 1 year. The mean age was 67.6±10.2 years, 24% were female, and 29% had diabetes. At 1 year, patients with focal coronary artery disease reported less angina than those with diffuse disease (Seattle Angina Questionnaire angina frequency score, 95.3±9.9 versus 92.5±15.0; P=0.006). PPG was independently associated with improvement in angina (P=0.017).

Conclusions: In patients with flow-limiting coronary artery disease, a focal disease pattern defined by high PPG was associated with greater symptomatic relief at 1 year compared with diffuse disease (low PPG). By capturing the underlying pathophysiologic distribution of epicardial disease and its relation to post-treatment symptom relief, PPG may support a more tailored revascularization decision-making and percutaneous coronary intervention strategy.

Keywords

Humans, Female, Male, Aged, Prospective Studies, Middle Aged, Percutaneous Coronary Intervention, Angina Pectoris, Time Factors, Coronary Artery Disease, Treatment Outcome, Fractional Flow Reserve, Myocardial, Predictive Value of Tests, Cardiac Catheterization, Patient Reported Outcome Measures, coronary artery bypass, coronary artery disease, patient-centered care, percutaneous coronary intervention, physicians

Published Open-Access

yes

Recommended Citation

Mizukami, Takuya; Ikeda, Kazumasa; Munhoz, Daniel; et al., "Influence of Pullback Pressure Gradient on Residual Angina at One Year" (2026). Faculty, Staff and Student Publications. 3615.
https://digitalcommons.library.tmc.edu/uthmed_docs/3615